1. Patterns and Correlates of PrEP Drug Detection Among MSM and Transgender Women in the Global iPrEx Study
- Author
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Liu, Albert, Glidden, David V, Anderson, Peter L, Amico, K Rivet, McMahan, Vanessa, Mehrotra, Megha, Lama, Javier R, MacRae, John, Hinojosa, Juan Carlos, Montoya, Orlando, Veloso, Valdilea G, Schechter, Mauro, Kallas, Esper G, Chariyalerstak, Suwat, Bekker, Linda-Gail, Mayer, Kenneth, Buchbinder, Susan, and Grant, Robert
- Subjects
Public Health ,Biomedical and Clinical Sciences ,Clinical Sciences ,Health Sciences ,Behavioral and Social Science ,Clinical Trials and Supportive Activities ,Sexual and Gender Minorities (SGM/LGBT*) ,Clinical Research ,Infectious Diseases ,Health Disparities ,6.1 Pharmaceuticals ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Infection ,Adolescent ,Adult ,Anti-Retroviral Agents ,Blood Chemical Analysis ,Chemoprevention ,Disease Transmission ,Infectious ,Drug Utilization ,Female ,HIV Infections ,Homosexuality ,Male ,Humans ,Male ,Medication Adherence ,Middle Aged ,Pre-Exposure Prophylaxis ,Transgender Persons ,United States ,Young Adult ,pre-exposure prophylaxis ,drug detection ,emtricitabine/tenofovir ,adherence ,men who have sex with men ,iPrEx Study team ,Public Health and Health Services ,Virology ,Clinical sciences ,Epidemiology ,Public health - Abstract
BackgroundAdherence to pre-exposure prophylaxis (PrEP) is critical for efficacy. Antiretroviral concentrations are an objective measure of PrEP use and correlate with efficacy. Understanding patterns and correlates of drug detection can identify populations at risk for nonadherence and inform design of PrEP adherence interventions.MethodsBlood antiretroviral concentrations were assessed among active arm participants in iPrEx, a randomized placebo-controlled trial of emtricitabine/tenofovir in men who have sex with men and transgender women in 6 countries. We evaluated rates and correlates of drug detection among a random sample of 470 participants at week 8 and a longitudinal cohort of 303 participants through 72 weeks of follow-up.ResultsOverall, 55% of participants (95% confidence interval: 49 to 60) tested at week 8 had drug detected. Drug detection was associated with older age and varied by study site. In longitudinal analysis, 31% never had drug detected, 30% always had drug detected, and 39% had an inconsistent pattern. Overall detection rates declined over time. Drug detection at some or all visits was associated with older age, indices of sexual risk, including condomless receptive anal sex, and responding "don't know" to a question about belief of PrEP efficacy (0-10 scale).ConclusionsDistinct patterns of study product use were identified, with a significant proportion demonstrating no drug detection at any visit. Research literacy may explain greater drug detection among populations having greater research experience, such as older men who have sex with men in the United States. Greater drug detection among those reporting highest risk sexual practices is expected to increase the impact and cost-effectiveness of PrEP.
- Published
- 2014